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Adult health2 > BPH, Prostate and Testicular Cancer > Flashcards

BPH, Prostate and Testicular Cancer Flashcards

1
Q

What is BPH?

A

An enlargement of the prostate gland

It develops in the inner portion of the prostate

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2
Q

What are risk factors for BPH

A 
family history
environment
diet
smoking 
chronic conditions 
increased weight
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3
Q

What are the obstructive clinical manifestations of BPH

A

decrease in force of urinary stream
difficulty initiating voiding
intermittency
dribbling at the end of voiding

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4
Q

What are the irrigtative clinical manifestations of BPH

A 
urinary frequency 
urgency 
dysuria 
bladder pain 
nocturia 
incontinence
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5
Q

What are complications of BPH

A

Acute urinary retention

UTI

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6
Q

How do you diagnose BPH?

A

History and Physical
DRE (distal rectal exam)
PSA
Trans rectal ultrasound (TRUS)

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7
Q

What are the goals for a patient with BPH?

A

restore bladder drainage
relieve the patients symptoms
prevent or treat complications

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8
Q

Pharmacologically how do you treat BPH?

A 
5 alpha reductase inhibitors 
   PROSCAR (finasteride)
   Avodart (dutasteride)
Alpha adranergic receptor blockers 
   Cardura (doxazosin)
   Hytrin (terazosin)
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9
Q

What minimally invasive therapy can be done for BPH?

A

Transurethral microwave thermotherapy
Transurethral needle ablation of prostate
Laser prostatectomy
Intraprostatic urethral stents

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10
Q

What is Transurethral Resection of the Prostate (TURP)?

A

Removal of prostate tissue
GOLD STANDARD FOR BPH
Bladder irrigation

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11
Q

What occurs during a TURP procedure?

A

A movable loop is inserted and tissue is removed and coagulated
Irrigation solution carries out debris
Bleeding is common complication

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12
Q

What are pre-op priorities for a TURP procedure?

A

Assess clotting factors

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13
Q

Qht are post-op priorities for a TURP procedure?

A

Let them know that clots are normal for 24-36 hours post op

Hematuria is also normal

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14
Q

What is continuous bladder irrigation?

A

Normal Saline irrigation for 24hrs after a TURP
Adjust irrigation fluid to maintain colorless or pink drainage return
Tape cath to leg to provide gentle traction-ballon at end of catheter is pulled down into prostatic tissue removal area to put pressure on area and maintain hemostasis

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15
Q

What are complications of TURP and CBI?

A

Potential hemorrhage
depending on how much bleeding; hypovolemia could occur
Bladder spasms- antispasmotics such as oxybutynin (Ditropan)

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16
Q

What does the patient need to know when they go home after having a TURP procedure?

A

May go home with catheter and need care of indwelling catheter
Increase oral fluids 2 to 3 L
S/S of UTI
Avoid heavy lifting
Driving and sexual intercourse after follow up care with the physician

17
Q

What are the pre-op goals for a patient having a TURP?

A

restoration of urinary drainage
treatment of UTI
understanding of procedure

18
Q

What are the post-op goals for a patient having a TURP?

A

No complications
Restoration of urinary control
Complete bladder emptying

19
Q

What is some basic info on prostate cancer?

A

asymptomatic in the early stages
family history increases risk
eventually may experience symptoms similar to BPH
5 year survival with diagnosis at local stage = 100%

20
Q

What are clinical manifestations of prostate cancer?

A 
dysuria 
hesitancy 
dribbling 
frequency
urgency
hematuria 
nocturia
retention 
inability to urinate
21
Q

What are late signs of prostate cancer?

A

Pain in lumbosacral area that radiates to hips or legs when coupled with urinary symptoms, could indicate metastasis
Once cancer has spread to distant sites, pain management becomes a problem

22
Q

Where can prostate cancer metastasize to?

A

pelvic lymph nodes
bladder
lungs (SOB)
liver (jaundice, trouble metabolizing drugs, elevated LFTs)

23
Q

How do you diagnose prostate cancer?

A

PSA (prostate-specific antigen) blood test
elevated levels indicate prostate pathology, not necessarily cancer
also used to monitor success of treatment
some concern about false positive/negative
levels should decrease after successful treatment
normal level is between 0-4
Digital rectal examination (DRE)
CT
MRI

24
Q

How can you definitively diagnose prostate cancer

A

by a biopsy obtained using TRUS (trans-rectal ultrasound)

25
Q

What are the treatment options for prostate cancer?

A 
surgery
chemotherapy 
radiation
hormone therapy 
watch and wait 
  life expectancy of less than 10 yeaars 
  presence of significant co-morbid condition
  low-grade, low-stage tumor
26
Q

What is a radical prostatectomy

A

The entire gland, seminal vesicles and part of the bladder neck are removed
Retroperineal lymph node dissection usually done
Considered most effective for long-term survival

27
Q

What are the complications of a radical prostatectomy?

A 
Major complications are ED and urinary incontinence 
Hemorrhage 
Urinary retention 
Infection
Wound dehiscence 
DVT/PE
28
Q

What are the detail of a nerve-sparing surgical procedure for prostate cancer?

A

spares nerve responsible for erection
only for cancer confined to prostate
no guarantee potency will be maintained
success is variable

29
Q

Waht type of therapies can be done for prostate cancer?

A 
external beam
brachytherapy 
  implantation of radioactive seed into prostate gland
  spares surrounding tissue 
hormonal therapy
30
Q

What is an orchiectomy?

A

surgical removal of testes for advanced stages of prostate cancer
reduces circulating testosterone by 90%
helps relieve bone pain with advanced tumors

31
Q

What are side effects of an orchiectomy?

A 
hot flashes 
ED 
loss of libido
irritability
weight gain
loss of muscle mass
32
Q

What are the outcomes for patients with prostate cancer?

A

be an active participant in the treatment plan
achieve satisfactory control
follow the therapeutic plan
understand the effect of the treatment on sexual function
satisfactory manage the impact on bowel and bladder function

33
Q

What is testicular cancer?

A

relatively rare
most common type of cancer in young men (15-34)
more common in males who have undescended testes
occurs more commonly in the right testicle
most develop from embryonic germ cells
may have slow or rapid onset
may notice lump or swelling in scrotum
mass is typically non-tender and firm
self-exam is vital in detection process

34
Q

how do you diagnose testicular cancer?

A 
palpation of mass
ultrasound 
AFP
HCG
LDH
35
Q

How do you treat testicular cancer?

A 
orchiectomy 
radical orchiectomy 
  removal of affected testes, spermatic cord and regional lymph nodes 
radiation 
chemo 
fertility issues

Adult health2 (5 decks)

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